Lewy Body Disease? - Parkinson Research Foundation Parkinson Research Foundation Weekly Journal Lewy Body Disease? The son and daughter of the patient bring her to the movement disorder specialist with a provisional diagnosis of Lewy Body Disease. Frederic Lewy gave his name to the bits of protein he found in the cytoplasm of cells throughout the brain in the early 1900s. The illness is characterized by dementia, fluctuations in cognition- attention, alertness and thinking ability from day to day, and Parkinsonism. Lewy Body Disease might have made a more simple patient case. The actual patient had a history of high blood pressure, neurosurgery to correct a potentially fatal aneurysm, which Wikipedia defines as a “blood-filled dilation (balloon-like bulge) of a blood vessel caused by disease or weakening of the vessel wall.” Neuroradiology discovered a tumor on her cerebellum while performing an MRI to ascertain the state of the aneurysm. The children of the patient noted she had trouble finding the appropriate words for objects, following surgery, an observation that coincides with an aneurysm on the left side of the brain, the language center.

After surgery, patients routinely receive Dilantin, prophylactically, to avoid seizures caused by minute scarring of cortical tissue. The patient never took the medication and suffered a seizure in the presence of her 85-year-old husband. The children also reported an incident in which the patient, “went crazy” after her medications were changed. Though the craziness subsided with new drugs, she still suffered from significant mental changes, for example she could not report her correct age. With all her troubles, the children of the patient commented she was in good health and rarely needs medical attention. On physical examination, the specialist noted tremor in her left hand and arm with less involvement on the right side. He felt some rigidity, more on the left than right, when the patient was distracted by performing a concurrent activity- in this case; she tapped her palm on her thigh. Parkinsonism also appeared as decreasing amplitude in repeated finger to thumb tapping. Of note also were brisk reflexes and upward going toes- a Babinski sign indicative of brain disease, specifically damage to the corticospinal tracts. The patient felt incapable of independent walking, so the physician gauged her standing and balance skills.

Without support, she could stand with feet touching, though the left side of her body twitched noticeably. With her eyes closed, she stood considerably less still and when jostled she lost balance quickly. The patient complained most about the tremor on the left side of her body. This symptom is what the specialist addressed, by recommending a medication that successfully quells tremor that would not interact with her other medications. To complicate matters a bit more, the doctor learned the patient refuses to take any medications given to her by her husband, with whom she lives. The patient fears he is trying to kill her. For this reason, an independent person must visit the home bringing the necessary drugs. When the dilemma unfolded, the physician commented Medicare pays for home health to dispense medications. He wrote a prescription for this service, as well as for physical therapy. The patient left the office on the arm of her son, and was clearly unstable with tremor rocking the left side of her torso.

Share this: Sex and Coffee may Trigger Aneurysm Rupture Home / Health News / Anti-Aging / Sex and Coffee may Trigger Aneurysm Rupture Sex and Coffee may Trigger Aneurysm Rupture Pin It An aneurysm is a localized, blood-filled balloon-like bulge in the wall of a blood vessel. Aneurysms can commonly occur in arteries at the base of the brain and an aortic aneurysm occurs in the main artery carrying blood from the left ventricle of the heart. Severe cases of aneurysms may result in hemorrhages and, eventually death. A study published online on May 5 in the journal Stroke: Journal of the American Heart Association , revealed that certain activities, such as drinking coffee, having sex, and getting angry, can cause an aneurysm to rupture, and possibly bring about death. Dr. Sahil Parikh, assistant professor of medicine at University Hospitals Case Medical Center in Cleveland admits that while the likelihood is small, people currently diagnosed with aneurysms should avoid those activities as much as possible.

THE STUDY In the study, which was conducted over the course of 3 years, Dutch researchers interviewed 250 patients over the age of 18 who had suffered a ruptured brain aneurysm about their exposure and connected them with 30 possible triggers. The researchers identified several actions that raise the risk of burst aneurysm, including: 1. Being startled – Increases risk 23 times / Cause of 2.7% of ruptures 2. Sexual Intercourse – Increases risk 11 times / Cause of 4.3% of ruptures 3. Straining for defecation – Increases risk 7 times / Cause of 3.6% of ruptures 4. Being Angry – Increases risk 6 times / Cause of 1.3% of ruptures 5. Drinking Coffee – Increases risk 2 times / Cause of 10.6% of ruptures 6. Drinking Cola – Increases risk 2 times / Cause of 3.5% of ruptures 7. Nose Blowing – Increases risk 2 times / Cause of 5.4% of ruptures 8.

Vigorous Physical Activity – Increases risk 2 times / Cause of 7.9% of ruptures The study is not without its critics, however. Ralph L. Sacco, MD, professor and chair of neurology at the Miller School of Medicine, University of Miami, states that people’s ability to recall exactly what they did in the period before the stroke, among other things, creates limitations for the study and its results. He admits, though, that it is a “novel study design that suggests certain triggers may be important in the rupture of brain aneurysms causing bleeding strokes.” He says that the eight triggers cited by the researchers are, indeed, plausible. WHAT TO DO The lead author of the study, Dr. Monique H.M. Vlak, believes that the factor that ties all 8 of the activities together to increase the risk of aneurysm rupture is high blood pressure. Despite the fact that 2% of the population has an aneurysm, and some may not be even aware of it, she notes that people should not excessively worry about it and simply suggests that if you believe you are at risk of an aneurysm, you should consult with your doctor and get professional advice.

For those who have aneurysms, she advises them not to take caffeine at all, and to use laxatives if constipated. Finally, exercise, she believes, heavily outweighs the negatives it could possibly cause with its positives, including lowering the risk of heart disease and stroke, so she encourages it. Aneurysms can be operated on, but some are more difficult cases than others, making the operation a major risk, so it is best to deal with the problem before it becomes worse. According to the Brain Aneurysm Foundation , there are 25,000 to 27,000 ruptures a year, 40% of which are fatal, in the United States alone. Aneurysms - Credo Reference Topic Page: Aneurysms Definition: aneurysm from Benders' Dictionary of Nutrition and Food Technology Local dilatation (swelling and weakening) of the wall of a blood vessel, usually the result of ATHEROSCLEROSIS and HYPERTENSION; especially serious in the aorta, where rupture may prove fatal.

Summary Article: Aneurysms from Encyclopedia of Global Health Image from: aneurysm in The Royal Society of Medicine Health Encyclopedia An aneurysm is defined as a localized, pathological, blood-filled dilatation of a blood vessel caused by a disease or weakening of the vessel’s wall. These diseases include, but are not limited to, atherosclerosis, hypertension, syphilis, trauma, congenital malformations, and bacterial and fungal infections. Aneurysms fall into one of two general categories: True aneurysms, which involve all three layers of the artery (intima, media, and adventitia), and false aneurysms, which do not involve all of the layers. Aneurysms most commonly occur in the abdominal aorta, thoracic aorta, and intracranial arteries, but can also affect the coronary, femoral, popliteal, splenic, carotid, and renal arteries. The shape of an aneurysm is either saccular (like a sack) or fusiform (like a spindle). Both are susceptible to growth, rupture, and dreadful consequences.

ABDOMINAL AORTIC ANEURYSMS Abdominal aortic aneurysms (AAA) are defined as an aortic diameter of at least 1.5 times the diameter measured at the level of the renal arteries. In most people, this diameter works out to be 3 centimeters. Abdominal aortic aneurysms are the most common type of aneurysms and occur between the renal and inferior mesenteric arteries. (Anything located more superiorly is a thoracic aortic aneurysm.) They are true aneurysms and therefore involve all layers of the aorta. Atherosclerosis is considered the most common cause of AAA, although other etiologies include cystic medial necrosis and infections. Aneurysms are also associated with diseases such as Marfan and Ehlers-Danlos syndromes. In the United States, AAA kills 15,000 people per year and is the 10th most common cause of death for people older than 55 years. Why and how abdominal aortic aneurysms develop is uncertain, although there are theories.

The fact that AAA develops in many members of some families suggests a genetic basis, and chromosome 19 has been implicated. Another possibility involves enzymes called proteases that destroy important components of the arterial wall such as elastin and collagen. Finally, it is thought that inflammation in the arterial wall may play a role in the development of AAA as well. Risk factors for the development of AAA include age greater than 60 (5 to 10 percent prevalence), male sex, Caucasian race, atherosclerosis, hypertension, and a family history of the disease. The strongest risk factor for developing AAA, however, is cigarette smoking. Cigarette smoking carries an odds ratio of 5 (i.e., a smoker is five times more likely to develop AAA than a nonsmoker) and a longer history of smoking confers a greater risk. It is estimated that smoking alone causes 75 percent of all AAA greater than 4 centimeters in diameter. Smoking also increases the rate at which an aneurysm grows. Patients with AAA are frequently asymptomatic and the disease is discovered only incidentally via imaging studies obtained for other reasons. The two most important symptoms are abdominal or back pain as well as abdominal tenderness to palpation.

Other findings on physical examination may include a pulsatile mass at or above the navel, which is approximately where the aorta divides and a common location for AAA, as well as an audible bruit (a harsh, shooting sound of blood flowing) when the abdomen is auscultated with a stethoscope. Patients with a ruptured aneurysm will be hypotensive due to exsanguination of blood into the abdominal cavity; the survival rate of patients with ruptured AAA is less than 50 percent. The diagnosis of AAA can be accomplished with physical examination and imaging studies. As mentioned, physical examination may reveal a pulsatile abdominal mass. Imaging studies include ultrasonography (preferred), computed tomography (CT), and magnetic resonance imaging (MRI).A small percentage of patients with AAA have an entity called inflammatory aneurysm. Additional findings of inflammatory aneurysm include weight loss and an elevated erythrocyte sedimentation rate (a type of blood measurement indicative of systemic inflammation). The treatment of AAA is medical and/or surgical. Medical therapy involves quitting cigarette smoking, as well as reducing risk factors such as high blood pressure and high cholesterol (such as with beta-blocker and statin medications, respectively).

Researchers are also looking into the role of antibiotic therapy, given the role that infection may play in AAA development. Records show that surgery for AAA was attempted since the 100s c.e. in ancient Rome, but success did not occur until the 1920s. Surgical therapy involves replacement of the aneurysm with a prosthetic graft, although endovascular techniques are also being developed. The indications for surgery include aneurysms that are symptomatic and any aneurysm greater than 5.5 centimeters in diameter. Cases that are planned in advance are now associated with a low mortality rate of less than 5 percent, but emergent cases for aneurysm rupture have a mortality rate of greater than half. The chances for surgical success are improved at a hospital and with a surgeon who does many procedures repairing AAA. Just like there are risk factors for aneurysm development, there are risk factors for aneurysm rupture. These factors include aneurysm diameter, rate of expansion, and gender.

The annual rupture risk depends on the size of the aneurysm diameter: 0 percent for aneurysms less than four centimeters, 3 percent for aneurysms four to five centimeters, 10 percent for five to six centimeters, 15 percent for six to seven centimeters, 30 percent for seven to eight centimeters, and 40 percent for aneurysms greater than eight centimeters. In terms of aneurysmal expansion rate, the faster an aneurysm expands, the increased risk it has of rupturing. In addition, larger aneurysms tend to expand more rapidly. Last, although males are more likely to develop AAA, females have a four times higher risk of aneurysm rupture. Other factors that increase the risk of AAA rupture include smoking and hypertension. Patients at risk of developing AAA should undergo screening examinations. Men between the age of 65 and 75 should be screened once with ultrasound if they ever smoked cigarettes. Men who are older than 60 years with a nuclear family history of AAA should also be screened.

Other current recommendations are to monitor aneurysms three to four centimeters in diameter with ultrasound every few years, while aneurysms four to five centimeters in diameter should be monitored with ultrasound or CT every six to 12 months. THORACIC AORTIC ANEURYSMS Thoracic aortic aneurysms (TAA) are less common than abdominal aortic aneurysms but are just as frightening. Even more frightening is the fact that one-fifth to one-fourth of patients with TAA have a coexisting AAA. TAA occur at an incidence of six per 100,000 patient-years and are more common in males in their 50s and 60s. TAA are divided into four anatomic categories: ascending aorta, aortic arch, descending aorta, and thoracoabdominal. Two classification systems exist, namely the DeBakey and Stanford systems. Aneurysms that originate in the ascending aorta and involve the aortic arch (30 percent of TAA) are termed DeBakey Class I. DeBakey Class II aneurysms involve the ascending aorta only (20 percent).

DeBakey Class III aneurysms originate in the descending aorta and comprise the other half of TAA. In the Stanford system, group A aneurysms have involvement of the ascending aorta, while group B aneurysms involve only the aortic arch and descending aorta. Cystic medial degeneration (or necrosis) is a natural process whereby the middle layer of an artery degenerates and consequently weakens the blood vessel. Atherosclerosis is a major cause of cystic medial degeneration, as is protease-mediated breakdown of vascular proteins such as elastin and collagen. These processes are the pathophysiology behind vessel dilatation and TAA formation. The biggest risk factor for cystic medial degeneration and TAA is hypertension. Two genetic conditions also present patients with a higher risk of developing TAA, namely Marfan and Ehlers-Danlos syndromes. Other risk factors include a family history (which is often due to mutations in the transforming growth factor beta receptor 2 gene), a bicuspid aortic valve, and infectious or inflammatory disorders of the esophagus (such as giant cell arteritis, syphilitic aortitis, etc.). Patients with TAA are usually asymptomatic.

Symptoms, when they do occur, are usually due to compression of other structures and vessels by the aneurysm, or from emboli spewed off from the aneurysm causing ischemia of different organs. Such symptoms can include pain in the chest, back, flank, or abdomen. Furthermore, compression of the vagus or recurrent laryngeal nerves can cause vocal hoarseness; compression of the trachea, bronchi, or lungs can cause respiratory symptoms such as wheezing, coughing, or shortness of breath; compression of the phrenic nerve can cause paralysis of the diaphragm; and compression of the esophagus can cause problems with swallowing. Also, an ascending TAA can cause aortic regurgitation, which can itself cause heart failure. A ruptured TAA can cause pain, hypotension, shock, or even hematemesis (coughing up blood). The most important factor related to the actual rupture of TAA is the aneurysm size.

The five-year risk of rupture is 0 percent for aneurysms less than 40 millimeters in diameter, 15 percent for aneurysms 40 to 59 millimeters, and 30 percent if the aneurysm is 60 millimeters or larger. On average, ascending TAA are about 60 millimeters in diameter at time of rupture while descending TAA are about 70 mm. Thoracic aortic aneurysms grow anywhere between one to 10 millimeters per year, and the aneurysms that grow fastest are the ones that are already large or are located along the descending aorta. The preferred methods of diagnosing TAA are CT and magnetic resonance angiography (MRA). Other options include chest X-ray, echocardiography, and contrast angiography. The medical treatment of asymptomatic TAA includes blood pressure control (with beta-blocker medications), surveillance, and serial imaging to monitor the growth of the aneurysm.

Aneurysms require surgical intervention if the patient is symptomatic; the size of the aneurysm is greater than 50 millimeters or 60 millimeters for ascending and descending aortic aneurysms, respectively; the aneurysm grows faster than 10 millimeters in a year; or there is evidence of aortic dissection. Surgical repair involves substituting a graft for the diseased section of aorta. Outcomes following surgery reveal the problematic nature of this disease. The one-month mortality rate is at least 10 percent (greater than 40 percent if the surgery is emergent), stroke rate is 20 percent for ascending aneurysms, and injury rates of the spine and/or kidneys are 15 percent for descending aneurysms. Patient factors predictive of poor outcome following surgery include symptomatic aneurysms, preoperative kidney disease, older age, and descending aneurysms. Another option for aneurysm repair is endovascular stenting. This new technique is minimally invasive and has been shown to be associated with fewer perioperative complications when compared to surgery. However, long-term follow-up has not yet shown an advantage.

Undoubtedly, this technology will continue to improve and one day present a viable option for patients. BRAIN ANEURYSMS Cerebral aneurysms are the primary cause of subarachnoid hemorrhage (SAH); therefore, the discussion of one is equivalent to a discussion of the other. Most cerebral aneurysms are of the saccular (berry) type, and the prevalence is estimated to be 5 percent; in other words, 300 million people worldwide have at least one brain aneurysm (approximately one-fourth of patients have two or more). Fortunately, most of these are small enough to be asymptomatic and remain unruptured; aneurysmal SAH occurs at a rate of “only” approximately 12 per 100,000. The average age of cerebral aneurysm rupture is 51 years, and certain risk factors exist that predispose people to aneurysm formation. The most preventable risk factor is cigarette smoking, which increases the risk of aneurysm formation by 2.5 to 5 times compared to nonsmokers.

This relationship is also dose dependent, so the more one smokes, the greater risk one has of developing a brain aneurysm. Other strong risk factors include a family history, which increases the risk by four times; hypertension, which increases the risk by 2.5 times; and alcohol, which increases the risk by a factor of 1.5 to 2. Genetics, the medication phenylpropanolamine, and estrogen deficiency are also thought to play a role in the development of aneurysms. Aneurysms of the brain cause symptoms in two circumstances: if it is large enough or if it ruptures. The major symptom of a ruptured aneurysm is a headache, usually described as “the worst headache of my life.” Other symptoms include loss of consciousness, nausea and vomiting, seizures, and even low back pain. A finding on physical examination, aside from potential neurologic deficits, is retinal hemorrhages. The most useful tool in diagnosing SAH is a head CT scan without contrast.

If the head CT scan is normal, it may have missed the SAH, so a lumbar puncture may contribute to the diagnosis if there is an elevated opening pressure or red blood cell count in the cerebrospinal fluid (CSF). Other diagnostic tools include cerebral angiography and MRI. Treating cerebral aneurysms can be performed with surgery or with endovascular techniques, but only one-third of patients will have favorable results. Surgical intervention is also known as aneurysm “clipping.” In this procedure, the patient receives a craniotomy which allows the neurosurgeon access to the aneurysm. Then, the neurosurgeon places a titanium clip at the base of the aneurysm. This occludes blood flow into the aneurysm and prevents or controls bleeding for unruptured or ruptured aneurysms, respectively. The endovascular treatment of brain aneurysms, also known as “coiling,” is a minimally invasive technique where the neurosurgeon or interventional radiologist enters the patient’s circulatory system through a peripheral vessel and thereby gains access to the cerebral vasculature.

Using real-time radiologic imaging, the aneurysm is located and a thin, flexible, wiry material is injected into it until the aneurysm is filled with coils. This also occludes the aneurysm, preventing blood flow and consequent rupture. The complications following SAH are many. The most important one is death. The fatality rate following SAH is 50 percent, with 10 percent of patients dying before reaching the hospital, another 15 percent dying within one day, and another 20 percent dying within one month. Other complications include increased intracranial pressure (ICP) (55 percent of patients), cerebral infarction (50 percent of survivors), vasospasm (34 percent of patients), cardiac dysfunction (20 percent of patients), hydrocephalus (15 percent of patients), seizures (7 percent of patients), rebleeding (7 percent of patients), and hyponatremia, all of which may lead to death. Vasospasm, also known as delayed ischemic neurologic deficit, is the leading cause of morbidity and mortality following aneurysm rupture and affects one-third of patients with SAH.

The pathogenesis of vasospasm is fascinating: When an aneurysm ruptures, blood comes into contact with the peri-adventitial space of the blood vessel, resulting in an upregulation of inflammatory cell mediators on the blood vessel wall as well as on circulating white blood cells. As a result, the white blood cells stick to the blood vessel wall and migrate through it, becoming entrapped in the subarachnoid space. This causes vasospasm in two ways. First, white blood cells are a source of endothelins, which are potent vasoconstrictors. Second, as the white blood cells die they release oxygen free radicals, which work to destroy the vasodilator nitric oxide (NO) that is normally released by the blood vessel wall. Patients with vasospasm present with symptoms of altered mental status and/or focal neurologic deficit (i.e., weakness, hemiparesis) anytime between the third and twentieth day following aneurysm rupture, although most commonly it occurs between the sixth and eighth day.

Transcranial doppler (TCD) studies can be used to detect vasospasm, although the tool is of low specificity and is particularly unhelpful in elderly patients, who have diminished vasomotor reactivity. The primary treatment and prevention of vasospasm involves hyperdynamic therapy (also known as triple-H therapy: hemodilution, hypertension, and hypervolemia). As mentioned, cerebral infarction (i.e., strokes) occurs in half of SAH survivors; the most common cause is vasospasm. Ten percent of all strokes are due to SAH. Cardiac dysfunction is due to inadequate blood flow to the hypothalamus, which results in an increase in hormone release within the heart and consequent injury. These changes are evident on electrocardiography (EKG). Hyponatremia is caused by injury to the hypothalamus and the syndrome of inappropriate antidiuretic hormone (SIADH) secretion. Screening for cerebral aneurysms is useful only in four select populations. First, patients with two or more first-degree relatives with aneurysms should receive screening.

So should patients with autosomal dominant polycystic kidney disease who have a personal or family history of aneurysm rupture, symptoms, a high-risk occupation, and/or an upcoming surgical procedure. Third, patients with gluco-corticoid-remediable aldosteronism should receive screening as these patients have a higher incidence of aneurysms. Last, patients with connective-tissue diseases such as Ehlers-Danlos syndrome or pseudo-xanthoma elasticum should also receive screening. Screening involves the use of MRA or computed tomography angiography (CTA). Patients selected for screening will need annual imaging done for the first three years; if these studies are normal, screening can be decreased in frequency to once every five years. SEE ALSO: Cholesterol; Ehlers-Danlos Syndrome; High Blood Pressure; Marfan Syndrome; Smoking. BIBLIOGRAPHY Keith D. Calligaro; Matthew J. Dougherty; Larry H. Hollier Diagnosis and Treatment of Aortic and Peripheral Arterial Aneurysms (Saunders, 1999).

Michael Forsting, Intracranial Vascular Malformations and Aneurysms: From Diagnostic Work-Up to Endovascular Therapy (Springer, 2004). George E. Pierce, Abdominal Aortic Aneurysms (Saunders, 1989). Sanjay Rajagopalan, et al., Peripheral Vascular Disease (Saunders, 2002). Tatsuzo Tanabe, Aortic Aneurysms: Pathophysiology, Diagnosis, and Treatment (Hokkaido University School of Medicine, 1993). James S.T. Yao; William H. Pearce, Aneurysms: New Findings and Treatments (Appleton & Lange, 1994). Khoi D. Than, M.D. Veins of the head and neck Flashcards a thrombus is a blood clot in an intact blood vessel A thrombus in a large blood vessel will decrease blood flow through that vessel . In a small blood vessel, blood flow may be completely cut-off resulting in death of tissue supplied by that vessel.

A thrombus is physiologic in cases of injury, but pathologic in case of thrombosis If a thrombus dislodges and becomes free-floating, it is an embolus.[image] Term embolus Definition an embolism occurs when an object (the embolus) migrates from one part of the bodycirculation and causes a blockage of a blood vessel in another part of the body This is in contrast with a thrombus, or clot, which forms at the blockage point within a blood vessel and is not carried from somewhere else[image] Term Definition the presence of bacteria in the blood. The blood is normally a sterile environment, so the detection of bacteria in the blood is always abnormal Bacteremia can have several consequences. The immune response to the bacteria can cause sepsis (blood poisoning) and septic shock, which has a relatively high mortality rate. Bacteria can also use the blood to spread to other parts of the body (which is called hematogenous spread), causing infections away from the original site of infection. Examples include endocarditis or osteomyelitis. Treatment is with antibiotics, and prevention with antibiotic prophylaxis can be given in situations where problems are to be expected.

Term hemorrhage Definition a seriously traumatized blood vessel can loose large amounts of blood into the surrounding tissue with out clotting, causing a hemorrhage Term hematoma Definition occurs when a blood vessel is injured and a small amount of the blood escapes into the surrounding tissue and then clots causes tenderness, swelling, and discoloratin that will last until the blood is broken down by the body Term cauliflower ear Definition If the external portion of the ear suffers a blow, a blood clot or other fluid may collect under the perichondrium. This separates the cartilage from the overlying perichondrium that is its source of nutrients, causing the cartilage to die. This leads to a formation of fibrous tissue in the overlying skin. When this happens, the outer ear becomes permanently swollen and deformed, thus resembling a cauliflower. Term aneurysm Definition a localized, blood-filled dilation (balloon-like bulge) of a blood vessel caused by disease or weakening of the vessel wall. Aneurysms most commonly occur in arteries at the base of the brain (the circle of Willis) and in the aorta (the main artery coming out of the heart), a so-called aortic aneurysm.

The bulge in a blood vessel can burst and lead to death at any time. The larger an aneurysm becomes, the more likely it is to burst and since aneurysms naturally grow, given enough time they will inevitably reach the bursting point if undetected. Term angiogram Definition Angiography or arteriography is a medical imaging technique in which an X-ray image is taken to visualize the inside, or lumen, of blood vessels and organs of the body, with particular interest in the arteries, veins and the heart chambers. [image] which veins drain the dentition? What arteries are associated with those veins? Definition the posterior alveolar vein drains the pulp and periodontium of ALL maxillary teeth associated with the PSA artery the inferior alveolar vein drains the pulp and perdontium of ALL the mandibular teeth associated with the inferior alveolar artery Term Computed tomography (CT) Definition a medical imaging method employing tomography. Digital geometry processing is used to generate a three-dimensional image of the inside of an object from a large series of two-dimensional X-ray images taken around a single axis of rotation. also known as a cat scan[image] Term which veins form the retomandibular vein?

Definition the superficial temporal and the maxillary veins merge to form the retromandibular vein forms the external jugular vein at one point emerges from the parotid salivary gland Term which vein in the head contains valves? Definition origionates from the posterior division of the retromandibular vein terminates at the subclavian vein Term what is the difference between a thrombus and an embolus Definition a thrombus is a clot, and an embolus is a traveling clot Term in what ways could a dental hygiene procedure cause bactermia? Definition if any of the major blood vessels are punctured bacteria could be spread to the blood stream and travel to vital organs infection to the venous sinuses could be fatal the pterygoid plexus is near the maxillary tuberosity and communicates with the cavernous venous sinus- therefore if a needle were to puncture and spread bacteria into the pterygoid plexus it could travel to the cavernous venous sinus Supporting users have an ad free experience! Types of Heart Surgery - NHLBI, NIH Types of Heart Surgery Share this page from the NHLBI on Blogger. Share this page from the NHLBI on Buzz. Share this page from the NHLBI on Delicious.

Share this page from the NHLBI on Digg. Share this page from the NHLBI on Facebook. Add this link to the NHLBI to my browser. Email this page with Gmail. Bookmark this page with Google. Share this page from the NHLBI on LinkedIn. Share this page from the NHLBI on Messenger. Share this page from the NHLBI on MySpace. Share this page from the NHLBI on Reddit. Share this page from the NHLBI on Stumble. Share this page from the NHLBI on Tumblr. Share this page from the NHLBI on Twitter. Types of Heart Surgery Coronary Artery Bypass Grafting Coronary artery bypass grafting (CABG) is the most common type of heart surgery. CABG improves blood flow to the heart. Surgeons use CABG to treat people who have severe coronary heart disease (CHD). CHD is a disease in which a waxy substance called plaque (plak) builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart. Over time, plaque can harden or rupture (break open). Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart.

This can cause chest pain or discomfort called angina (an-JI-nuh or AN-juh-nuh). If the plaque ruptures, a blood clot can form on its surface. A large blood clot can mostly or completely block blood flow through a coronary artery. This is the most common cause of a heart attack . Over time, ruptured plaque also hardens and narrows the coronary arteries. During CABG, a healthy artery or vein from the body is connected, or grafted, to the blocked coronary artery. The grafted artery or vein bypasses (that is, goes around) the blocked portion of the coronary artery. This creates a new path for oxygen-rich blood to flow to the heart muscle. Surgeons can bypass multiple blocked coronary arteries during one surgery. Coronary Artery Bypass Grafting Figure A shows the location of the heart. Figure B shows how vein and artery bypass grafts are attached to the heart. CABG isn't the only treatment for CHD. A nonsurgical procedure that opens blocked or narrow coronary arteries is percutaneous coronary intervention (PCI), also known as coronary angioplasty.

During PCI, a thin, flexible tube with a balloon at its tip is threaded through a blood vessel to the narrow or blocked coronary artery. Once in place, the balloon is inflated to push the plaque against the artery wall. This restores blood flow through the artery. During PCI, a stent might be placed in the coronary artery to help keep it open. A stent is a small mesh tube that supports the inner artery wall. If both CABG and PCI are options, your doctor can help you decide which treatment is right for you. Transmyocardial Laser Revascularization Transmyocardial (tranz-mi-o-KAR-de-al) laser revascularization (re-VAS-kyu-lar-ih-ZA-shun), or TMR, is surgery used to treat angina. TMR is most often used when no other treatments work. For example, if you've already had one CABG procedure and can't have another one, TMR might be an option. For some people, TMR is combined with CABG. If TMR is done alone, the procedure may be performed through a small opening in the chest.

During TMR, a surgeon uses lasers to make small channels through the heart muscle and into the heart's lower left chamber (the left ventricle). It isn't fully known how TMR relieves angina. The surgery may help the heart grow tiny new blood vessels. Oxygen-rich blood may flow through these vessels into the heart muscle, which could relieve angina. Heart Valve Repair or Replacement For the heart to work well, blood must flow in only one direction. The heart's valves make this possible. Healthy valves open and close in a precise way as the heart pumps blood. Each valve has a set of flaps called leaflets. The leaflets open to allow blood to pass from one heart chamber into another or into the arteries. Then the leaflets close tightly to stop blood from flowing backward. Heart surgery is used to fix leaflets that don't open as wide as they should. This can happen if they become thick or stiff or fuse together. As a result, not enough blood flows through the valve. Heart surgery also is used to fix leaflets that don't close tightly. This problem can cause blood to leak back into the heart chambers, rather than only moving forward into the arteries as it should.

To fix these problems, surgeons either repair the valve or replace it with a man-made or biological valve. Biological valves are made from pig, cow, or human heart tissue and may have man-made parts as well. To repair a mitral (MI-trul) or pulmonary (PULL-mun-ary) valve that's too narrow, a cardiologist (heart specialist) will insert a catheter (a thin, flexible tube) through a large blood vessel and guide it to the heart. The cardiologist will place the end of the catheter inside the narrow valve. He or she will inflate and deflate a small balloon at the tip of the catheter. This widens the valve, allowing more blood to flow through it. This approach is less invasive than open-heart surgery. Researchers also are testing new ways to use catheters in other types of valve surgeries. For example, catheters might be used to place clips on the mitral valve leaflets to hold them in place. Catheters also might be used to replace faulty aortic valves. For this procedure, the catheter usually is inserted into an artery in the groin (upper thigh) and threaded to the heart.

In some cases, surgeons might make a small cut in the chest and left ventricle (the lower left heart chamber). They will thread the catheter into the heart through the small opening. The catheter has a deflated balloon at its tip with a folded replacement valve around it. The balloon is used to expand the new valve so it fits securely within the old valve. Currently, surgery to replace the valve is the traditional treatment for reasonably healthy people. However, catheter procedures might be a safer option for patients who have conditions that make open-heart surgery very risky. Arrhythmia Treatment An arrhythmia (ah-RITH-me-ah) is a problem with the rate or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm. Many arrhythmias are harmless, but some can be serious or even life threatening. If the heart rate is abnormal, the heart may not be able to pump enough blood to the body. Lack of blood flow can damage the brain, heart, and other organs. Medicine usually is the first line of treatment for arrhythmias. If medicine doesn't work well, your doctor may recommend surgery.

For example, surgery may be used to implant a pacemaker or an implantable cardioverter defibrillator (ICD). A pacemaker is a small device that's placed under the skin of your chest or abdomen. Wires connect the pacemaker to your heart chambers. The device uses low-energy electrical pulses to control your heart rhythm. Most pacemakers have a sensor that starts the device only if your heart rhythm is abnormal. An ICD is another small device that's placed under the skin of your chest or abdomen. This device also is connected to your heart with wires. An ICD checks your heartbeat for dangerous arrhythmias. If the device senses one, it sends an electric shock to your heart to restore a normal heart rhythm. Another arrhythmia treatment is called maze surgery. For this surgery, the surgeon makes new paths for the heart's electrical signals to travel through. This type of surgery is used to treat atrial fibrillation , the most common type of serious arrhythmia. Simpler, less invasive procedures also are used to treat atrial fibrillation. These procedures use high heat or intense cold to prevent abnormal electrical signals from moving through the heart.

Aneurysm Repair An aneurysm (AN-u-rism) is a balloon-like bulge in the wall of an artery or the heart muscle. This bulge can occur if the artery wall weakens. Pressure from blood moving through the artery or heart causes the weak area to bulge. Over time, an aneurysm can grow and burst, causing dangerous, often fatal bleeding inside the body. Aneurysms also can develop a split in one or more layers of the artery wall. The split causes bleeding into and along the layers of the artery wall. Aneurysms in the heart most often occur in the heart's lower left chamber (the left ventricle). Repairing an aneurysm involves surgery to replace the weak section of the artery or heart wall with a patch or graft. Heart Transplant A heart transplant is surgery to remove a person's diseased heart and replace it with a healthy heart from a deceased donor. Most heart transplants are done on patients who have end-stage heart failure . Heart failure is a condition in which the heart is damaged or weak. As a result, it can't pump enough blood to meet the body's needs.

"End-stage" means the condition is so severe that all treatments, other than heart transplant, have failed. Patients on the waiting list for a donor heart receive ongoing treatment for heart failure and other medical conditions. Ventricular assist devices (VADs) or total artificial hearts (TAHs) might be used to treat these patients. Surgery To Place Ventricular Assist Devices or Total Artificial Hearts A VAD is a mechanical pump that is used to support heart function and blood flow in people who have weak hearts. Your doctor may recommend a VAD if you have heart failure that isn't responding to treatment or if you're waiting for a heart transplant. You can use a VAD for a short time or for months or years, depending on your situation. A TAH is a device that replaces the two lower chambers of the heart (the ventricles). You may benefit from a TAH if both of your ventricles don't work well due to end-stage heart failure. Placing either device requires open-heart surgery. Surgical Approaches Surgeons can use different approaches to operate on the heart, including open-heart surgery, off-pump heart surgery, and minimally invasive heart surgery.

The surgical approach will depend on the patient's heart problem, general health, and other factors. Open-Heart Surgery Open-heart surgery is any kind of surgery in which a surgeon makes a large incision (cut) in the chest to open the rib cage and operate on the heart. "Open" refers to the chest, not the heart. Depending on the type of surgery, the surgeon also may open the heart. Once the heart is exposed, the patient is connected to a heart-lung bypass machine. The machine takes over the heart's pumping action and moves blood away from the heart. This allows the surgeon to operate on a heart that isn't beating and that doesn't have blood flowing through it. Open-heart surgery is used to do CABG, repair or replace heart valves, treat atrial fibrillation, do heart transplants, and place VADs and TAHs. Off-Pump Heart Surgery Surgeons also use off-pump, or beating heart, surgery to do CABG. This approach is like traditional open-heart surgery because the chest bone is opened to access the heart. However, the heart isn't stopped, and a heart-lung bypass machine isn't used. Off-pump heart surgery isn't right for all patients.

Work with your doctor to decide whether this type of surgery is an option for you. Your doctor will carefully consider your heart problem, age, overall health, and other factors that may affect the surgery. Minimally Invasive Heart Surgery For minimally invasive heart surgery, a surgeon makes small incisions (cuts) in the side of the chest between the ribs. This type of surgery may or may not use a heart-lung bypass machine. Minimally invasive heart surgery is used to do some bypass and maze surgeries. It's also used to repair or replace heart valves, insert pacemakers or ICDs, or take a vein or artery from the body to use as a bypass graft for CABG. One type of minimally invasive heart surgery that is becoming more common is robotic-assisted surgery. For this surgery, a surgeon uses a computer to control surgical tools on thin robotic arms. The tools are inserted through small incisions in the chest. This allows the surgeon to do complex and highly precise surgery. The surgeon always is in total control of the robotic arms; they don't move on their own. Rate This Content: What Is an Aneurysm? - NHLBI, NIH Share this page from the NHLBI on Blogger.

Share this page from the NHLBI on Buzz. Share this page from the NHLBI on Delicious. Share this page from the NHLBI on Digg. Share this page from the NHLBI on Facebook. Add this link to the NHLBI to my browser. Email this page with Gmail. Bookmark this page with Google. Share this page from the NHLBI on LinkedIn. Share this page from the NHLBI on Messenger. Share this page from the NHLBI on MySpace. Share this page from the NHLBI on Reddit. Share this page from the NHLBI on Stumble. Share this page from the NHLBI on Tumblr. Share this page from the NHLBI on Twitter. What Is an Aneurysm? An aneurysm (AN-u-rism) is a balloon-like bulge in an artery. Arteries are blood vessels that carry oxygen-rich blood to your body. Arteries have thick walls to withstand normal blood pressure. However, certain medical problems, genetic conditions, and trauma can damage or injure artery walls. The force of blood pushing against the weakened or injured walls can cause an aneurysm. An aneurysm can grow large and rupture (burst) or dissect. A rupture causes dangerous bleeding inside the body.

A dissection is a split in one or more layers of the artery wall. The split causes bleeding into and along the layers of the artery wall. Both rupture and dissection often are fatal. Overview Most aneurysms occur in the aorta, the main artery that carries oxygen-rich blood from the heart to the body. The aorta goes through the chest and abdomen. An aneurysm that occurs in the chest portion of the aorta is called a thoracic (tho-RAS-ik) aortic aneurysm. An aneurysm that occurs in the abdominal portion of the aorta is called an abdominal aortic aneurysm. Aneurysms also can occur in other arteries, but these types of aneurysm are less common. This article focuses on aortic aneurysms. About 13,000 Americans die each year from aortic aneurysms. Most of the deaths result from rupture or dissection. Early diagnosis and treatment can help prevent rupture and dissection. However, aneurysms can develop and grow large before causing any symptoms. Thus, people who are at high risk for aneurysms can benefit from early, routine screening.

Outlook Doctors often can successfully treat aortic aneurysms with medicines or surgery if they’re found in time. Medicines may be given to lower blood pressure, relax blood vessels, and reduce the risk of rupture. Large aortic aneurysms often can be repaired with surgery. During surgery, the weak or damaged portion of the aorta is replaced or reinforced. Rate This Content:

Question: What name is given to a blood-filled balloon-like bulge in a blood vessel?
Answer: Aneurism